PMOS (PCOS) and Hair: Facial Hair Growth and Hair Loss Explained

PMOS (formerly PCOS) can affect hair in two opposite ways. Higher androgen levels can cause thick, dark hair on the face, chest, stomach or back (hirsutism), and can also thin the hair on your scalp (female pattern hair loss). Insulin resistance adds to the problem by pushing androgen levels higher. The treatments with the best evidence are medical and cosmetic. Food and lifestyle help your overall health, but change hair only slowly and modestly. This guide explains why it happens, how it is assessed, what the evidence says about diet, inositol and spearmint tea, and what else to check if your hair is shedding.

Why PMOS (PCOS) affects hair

Androgens are hormones such as testosterone. Everyone makes them, but many women with PMOS make more, or their hair follicles respond more strongly to them. On the face and body, androgens turn fine, almost invisible hairs into thicker, darker ones. On the scalp, the same hormones can do the opposite and gradually shrink the follicles.

Insulin is part of the story. Many women with PMOS have insulin resistance, even at a lower weight, although some do not. The body then makes extra insulin to compensate. Higher insulin prompts the ovaries to make more androgens and lowers sex hormone binding globulin (SHBG), the protein that keeps testosterone inactive in the blood. The result is more free testosterone reaching the hair follicles. That is why insulin keeps coming up in PMOS hair advice.

The 2023 guideline notes that insulin resistance is a key part of PMOS, but routine insulin blood tests are not accurate enough to be useful. Our guide to what insulin resistance is explains more.

Excess hair growth (hirsutism)

Hirsutism means coarse, dark hair in places where men typically grow it: the upper lip, chin, jawline, chest, around the nipples, the lower stomach, the back and the inner thighs. Healthdirect lists it as one of the visible symptoms of PMOS. It usually starts in the late teens and can get more noticeable with age.

Some hair in these areas is normal, and the normal amount differs between families and ethnic backgrounds. Shaving does not make hair grow back thicker. Hirsutism is about new or increased growth of the thick, pigmented hairs, not fine downy hair.

How hirsutism is assessed: the mFG score

Doctors use the modified Ferriman Gallwey (mFG) score. It rates hair in 9 body areas from 0 (none) to 4 (extensive), and the scores are added up. The 2023 International PCOS Guideline recommends a cut-off of 4 to 6 to detect hirsutism, depending on ethnicity. It also notes that the severity of hirsutism can vary by ethnicity, while how common it is appears similar across groups.

Two practical points from the guideline matter a lot. First, most women remove unwanted hair, which can hide how much there is at an appointment. Second, your own report of unwanted hair is considered valid and important, regardless of how it looks on the day. You do not need to stop shaving or waxing to be taken seriously. Saying “I remove hair from my chin every day” is useful information.

The guideline also says new, severe or rapidly worsening hair growth needs further tests, to rule out rarer causes such as androgen-secreting tumours.

Scalp hair thinning (female pattern hair loss)

Female pattern hair loss usually shows as thinning over the crown and a widening part, while the front hairline is generally kept. It is different from the patchy loss of alopecia areata. DermNet notes that most women with PMOS do not have scalp hair loss, and most women with female pattern hair loss have normal hormone levels.

The 2023 guideline treats scalp hair loss on its own as a weak sign of high androgens, so your doctor will look at the whole picture. Doctors use the Ludwig or Olsen scales to grade it. A 2019 report from the Androgen Excess and PMOS Society recommends checking for androgen excess in everyone with female pattern hair loss. It suggests also considering vitamin D, iron, zinc, thyroid and prolactin tests.

Other causes of hair shedding worth checking

Not all hair loss in PMOS comes from androgens. Telogen effluvium is a common, temporary shedding that starts 2 to 4 months after a “shock to the system”. DermNet lists triggers including illness, psychological stress, weight loss, unusual diets, nutritional deficiency such as low iron, thyroid problems and stopping the contraceptive pill. Shedding usually settles over 6 to 9 months once the trigger is dealt with. It is normal to lose up to about 100 hairs a day.

Ask your GP before taking iron or zinc supplements. A blood test shows whether you need one, and zinc has a safe upper limit for adults. Read more in our guides to why women need more iron and zinc supplements for women.

Does diet help PMOS (PCOS) hair growth?

This is where honest answers matter, because a lot of online advice overpromises. The 2023 guideline found no evidence that any one type of diet is better than another for hormonal or other PMOS outcomes. Any eating pattern in line with healthy eating guidelines has health benefits. The guideline also says a healthy lifestyle has benefits even without weight loss, and warns against unduly restrictive diets.

Two recent reviews look at hair specifically:

• A 2025 review of 21 trials found that diet, exercise and other non-drug approaches lowered testosterone. The mFG score fell by less than one point on average, and the certainty of the evidence was low.
• A 2024 review of 29 weight-loss comparisons (1,529 people) found improvements in insulin resistance, free androgens and periods. It found no clear improvement in hirsutism, possibly because the studies were too small to detect it.

So eating well and moving regularly are worth doing for insulin, cycles, energy and long-term health. They may support other treatments for hair, but they are unlikely to change hair much on their own. Hair also grows in long cycles, so any change takes many months to show. Our PMOS (PCOS) diet guide covers the eating patterns with the most evidence.

Inositol, spearmint tea and zinc: what the trials show

None of these is proven to reduce PMOS hair growth or regrow scalp hair. Spearmint tea is not a substitute for treatment. Our inositol and metformin guide goes into more detail.

Medical treatments: what to ask your doctor

These are prescription decisions for your GP, endocrinologist or dermatologist. In brief, the 2023 guideline says:

• Combined oral contraceptive pill. Can be recommended for hirsutism. Higher-oestrogen pills offer no extra benefit. It is preferred over metformin for hair growth.
• Anti-androgens. Medicines such as spironolactone block the effect of androgens. They are considered when hair has not responded enough after at least six months of the pill or cosmetic treatment, or when the pill is not suitable. Effective contraception is essential because they can affect a developing male baby.
• Metformin. Mainly used for metabolic reasons. For hair growth, other treatments are usually needed.
• Scalp hair loss. The guideline suggests anti-androgens with the pill could be tried, while noting limited evidence in PMOS. The Androgen Excess and PMOS Society report recommends topical minoxidil as a first step.
• Facial hair creams. The guideline does not cover these, but a 2019 review notes a prescription cream, eflornithine, can improve mild facial hirsutism. Ask your doctor whether it is suitable and available.

Patience is part of treatment. Hair responds slowly, and DermNet advises at least six months before judging whether a treatment for scalp hair loss is working.

Cosmetic options

Shaving, waxing, plucking, depilatory creams and bleaching are temporary but effective. Plucking, shaving and waxing can cause inflamed hair follicles (folliculitis). Electrolysis can be permanent, but needs a skilled operator.

The 2023 guideline recommends laser and light therapies for facial hirsutism. They can also help with related low mood, anxiety and quality of life. Women with PMOS may need more sessions than women with excess hair from no known cause. Laser works poorly on blond, grey or white hair, and side effects appear limited with an experienced, qualified provider. The guideline found no evidence that home IPL kits work. For thinning scalp hair, hair sprays, fibres and wigs can help while you wait for treatment to work.

The emotional side

Hair changes are not “just cosmetic”. The 2023 guideline asks health professionals to take unwanted hair and scalp hair loss seriously, however mild they look. It recognises that PMOS features can affect body image and quality of life. DermNet notes that hair loss is linked with distress and low self-esteem.

It is also common to feel pushed towards strict diets to “fix” your hormones. The guideline asks health professionals to watch for disordered eating in PMOS at any weight, and to be aware of weight stigma. If food or your body is taking up a lot of headspace, you deserve support with that too. Our eating disorder dietitian page explains how we help.

When to see your GP

See your GP if you notice new or increasing facial or body hair, a widening part or thinning crown, or shedding that has lasted more than a few months. See them promptly if hair growth comes on suddenly or worsens quickly, or comes with a deepening voice or other new body changes. These need checking for causes other than PMOS. Your GP can arrange blood tests (including iron and thyroid) and refer you to an endocrinologist or dermatologist. If you have not been diagnosed, our guide to PMOS (PCOS) symptoms explains what else to mention.